Mustard gas – from the Great War to frontline chemotherapy
One hundred years ago a great conflict began that would change the world forever. World War I, also known as the Great War, would leave 17 million people dead or missing in action. Stuck in the squalid conditions of the trenches, it was a living hell for those on the front line.
But it was made even worse by the work of industrial chemists.
In July 1917, troops based in Ypres, Belgium, reported a shimmering cloud around their feet and a strange peppery smell in the air. Within 24 hours they started to itch uncontrollably and developed horrific blisters and sores. Some started coughing up blood.
They’d been poisoned by mustard gas – one of the most deadly chemical weapons deployed in battle.
And because mustard gas can be absorbed through the skin, gas masks were useless. Even fully clothed soldiers weren’t fully protected. It could take up to six weeks to die from mustard gas, and it was a terrible way to die.
Towards the end of the Great War, this gas had not only killed and crippled but instilled terror across the battlefield. The first use in Ypres alone left up to 10,000 people dead, with many more injured.
Mustard gas was one of a number of weaponised poison gases developed by Fritz Haber, a Professor at the prestigious University of Karlsruhe. Haber was a brilliant chemist, who invented a process for the industrial scale production of ammonia-based fertiliser. This brilliant discovery, known as the Haber process, played a huge role in avoiding worldwide famines and now feeds about a third of the world’s population. It won him the Nobel Prize in Chemistry in 1918.
But Haber’s role in chemical weapons’ development means his legacy will always have its dark side.
Even after the war, Haber enthusiastically promoted the use of poison gas. And his colleagues would go on to make other deadly gases – World War I is known to some as the chemists’ war.
But the story of mustard gas didn’t end there. And it has a brighter ending than you might think.
The Truth About Chemotherapy – Toxic Poison or Cancer Cure?
Back in September 2004, the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety & Health (NIOSH) released a dangerous-drug alert with the title Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. The alert warned that working with chemotherapy drugs and other common pharmaceuticals can be a serious danger to your health.
They were right because on July 10, 2010, the Seattle Times carried the story of Sue Crump, a veteran pharmacist of 20 years, who had spent much of her time dispensing chemotherapy drugs. Sue died in 2011 from pancreatic cancer and one of her dying wishes was that the truth be told about how her on-the-job exposure to toxic chemotherapy drugs caused her own cancer. The list of chemicals Crump worked with included cyclophosphamide, doxorubicin, fluorouracil, and methotrexate.
Does Chemotherapy Cause Cancer?
I am not surprised by Sue’s story because one of the effects of chemotherapy is that it actually CAUSES cancer! (Yes, the very thing it is supposed to “cure” it literally causes. Insane, right?)
You may have heard it said that folks who live in glass houses shouldn’t throw stones. Well, much like the hatters who went mad from the mercury, when it comes to chemo… pharmacists and other health care workers who dispense toxic drugs shouldn’t be surprised if one day it kills them.
Interestingly, the federal Occupational Safety and Health Administration (OSHA) does not regulate exposure to these toxins in the workplace − despite multiple studies documenting ongoing contamination and exposures. Studies reaching back to the 1970s have linked increased rates of certain cancers to nurses and physicians.
Every oncologist knows that chemotherapy drugs cause genetic damage. Due to inadvertent spills, chemotherapy drugs have been found on floors, counter tops, knobs, keyboards, printers, computers, and garbage cans. Most chemo is genotoxic, meaning that it interacts with genes (DNA) and causes mutations. And yes, genetic mutations are a known risk factor for developing cancer, while secondary cancers are a known side effect (actually a “direct effect”) of chemo.
Danish epidemiologists used cancer data from the 1940s through the 1980s to report a significantly increased risk of leukemia among oncology nurses and doctors. In 2009, another Danish study of over 92,000 nurses determined that they had an increased risk for brain cancer, breast cancer, and thyroid cancer.
Chemocare.com uses generic names in all descriptions of drugs. Mustargen is the trade name for Mechlorethamine. Nitrogen Mustard, Mustine, and Mechlorethamine Hydrochloride are other names for Mechlorethamine. In some cases, health care professionals may use the trade name Mustargen or other names Nitrogen Mustard, Mustine, and Mechlorethamine Hydrochloride when referring to the generic drug name Mechlorethamine.
Drug type: Nitrogen Mustard is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug. Nitrogen Mustard is classified as an “alkylating agent.” (For more detail, see “How this drug works” section below).
What Nitrogen Mustard is used for:
- As part of combination regimens in treatment of Hodgkin’s disease, non-Hodgkin’s lymphoma.
- As palliative chemotherapy in lung and breast cancers.
- As a lotion to skin lesions of mycosis fungoides (cutaneous T-cell lymphoma).
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.
How Nitrogen Mustard is given:
- As an injection into the vein (intravenous, IV).
- Mechlorethamine is a vesicant. A vesicant is a chemical that causes extensive tissue damage and blistering if it escapes from the vein. The nurse or doctor who gives this drug must be carefully trained. If you notice redness or swelling at the IV site while you are receiving mechlorethamine, alert your health care professional immediately.
- Diluted solution applied to mycosis fungoides skin lesions.
- There is no pill form of mechlorethamine.
- The amount of mechlorethamine that you will receive and route depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.
Side effects of Nitrogen Mustard:
Important things to remember about the side effects of Nitrogen Mustard:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients taking Nitrogen Mustard:
- Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.
Onset: 4 – 7 days
Nadir: 14 days
Recovery: 21 days
- Nausea and vomiting. Usually occurs within first 3 hours after drug administration. You will be given anti-nausea medication before receiving drug.
- Hair loss
- Mouth sores
- Darkening of veins used for infusion
- Redness, dryness, irritation with topical use
- Loss of fertility. Meaning, your ability to conceive or father a child may be affected by mechlorethamine. Discuss this issue with your health care provider.
These side effects are less common side effects (occurring in about 10-29%) of patients receiving Nitrogen Mustard:
- Poor appetite
- Taste changes (metallic taste)
- Ringing in the ears (tinnitus) (see hearing problems)
- Abnormal blood tests: increased uric acid levels
Delayed effects of Nitrogen Mustard:
- There is a slight risk of developing a blood cancer such as leukemia after taking Nitrogen Mustard. Talk to your doctor about this risk.
Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
- Extreme fatigue (unable to carry on self-care activities)
- Mouth sores (painful redness, swelling or ulcers)
- Swelling, redness and/or pain in one leg or arm and not the other.
- Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting mechlorethamine treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor’s approval while taking mechlorethamine.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (mechlorethamine may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking mechlorethamine. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- If redness or swelling is noted at the IV infusion site, apply ice and notify your health care professional immediately.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
Monitoring and testing:
You will be checked regularly by your health care professional while you are taking mechlorethamine, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How Nitrogen Mustard works:
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. “Normal” cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The “normal” cells will grow back and be healthy but in the meantime, side effects occur. The “normal” cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Mechlorethamine is classified as an alkylating agent. Alkylating agents are most active in the resting phase of the cell. These drugs are cell cycle non-specific. There are several types of alkylating agents.
- Mustard gas derivatives: Mechlorethamine, Cyclophosphamide, Chlorambucil, Melphalan, and Ifosfamide.
- Ethylenimines: Thiotepa and Hexamethylmelamine.
- Alkylsulfonates: Busulfan.
- Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine and Temozolomide.
- Nitrosureas: Carmustine, Lomustine and Streptozocin. Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain barrier. They can be useful in treating brain tumors.
- Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.